Pre-donation weight loss in living kidney donation has two main objectives: reduce surgical risk, and decrease long-term complications from obesity and glomerular hypertrophy secondary to kidney mass reduction.

We retrospectively evaluated living kidney donors from a single center for pre- and post-donation weight changes, and compared clinical and renal outcomes. All donors since 2005 were included. Those with a follow-up inferior to 24months were excluded from the analysis. Estimated glomerular filtration rate (GFR) was calculated using CKD-Epi formula.

A total of 322 donors (34% male, aged 46±20 years old, serum creatinine 0.82±0.15mg/dL, GFR 92±24ml/min/1,73m2, median time to donation 3.6 months [IQR 2,0-6,68]) were evaluated. First visit average BMI was 26.6±4.3, with 48 patients (14.9%) presenting BMI > 30 (32.9±3.3 vs 25.2±2.9Kg/m2. On average, patients with BMI >30 lost significantly more weight pre-donation than the rest ([Delta]weight Kg:1.4 [0.2 – 6.4] vs 0.5Kg [0-1.0]; [Delta]BMI kg/m2: 0.5 [0.1-2,4] vs 0.2 [0.0-0.3]). There was a tendency to increased pre-donation proteinuria with BMI >30 (108±47 vs 94±41, p=.06). No differences between groups were found regarding age, gender, median time to donation, serum creatinine or GFR either at donation, or at 3 years follow-up.

We then looked for the impact of subtle weigh loss previous to donation, using a decrease of 2kg/m2 in BMI as cut-off. The twenty patients (6.2%) included were older (58±10 vs 52±11 years, p<.05), predominantly female (80%), with higher BMI (34,3±4,7 vs 26,0±3,6Kg/m2, p<.05), and increased proteinuria at first evaluation (120±63 vs 94±40mg/day, p<.05). Median weight loss pre-donation was 7.2kg [IQR 6.0-15.3], with a significant longer period from first visit to donation (9.7 [6.0-16.6] months vs 3.7 [2.0-7.5], p<.01). On follow-up, weight gain in these patients was significantly higher since month 6 (p<.005), up to 3 years (p<.001), having recovered more than 66% of the weight by the 3^rd year (picture 1). No differences were found regarding GFR, proteinuria, or microalbuminuria at this point.

In conclusion, weight loss previous to living kidney donation increases length to transplant, and is often regained as soon as 3 years post-donation. Efficient programs to prevent weigh regain in the post-donation period need to be implemented to prevent long-term complications.

CITATION INFORMATION: Ventura-Aguiar P, De Sousa-Amorim E, Campistol J, Diekmann F, Oppenheimer F, Revuelta I. Pre-Donation Weight Loss Postpones Living Kidney Donation without Attaining the Desired Weight Maintenance in the Midterm. Am J Transplant. 2016;16 (suppl 3).

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